‘We Believe in Science’: How Rwanda Became a Leader in Cervical Cancer Prevention

For most of her life, Josephine Kanyange has never experienced a serious health issue. But in 2020, she noticed a change in her menstrual cycle. “I had periods that were continuous for a whole month,” she recalled. Concerned, she visited a gynecologist, only to be told it was nothing serious. 

But Kanyange knew something wasn’t right. Trusting her instincts, she sought a second opinion. Additional testing and a biopsy revealed a large, cancerous tumor on her cervix. 

“The results were so devastating,” she said. She agonized over how she’d potentially leave this world.  

The 40-year-old mother of one underwent radiation and chemotherapy for a month, taking leave from her job as an administrative assistant to focus on her recovery. Despite the weeks of treatment and worry over her health, Kanyange considers herself fortunate. 

“I was so lucky; my cervical cancer [diagnosis] came in at the early stage,” she said. Because of this, she required only a low level of treatment with few severe side effects, all of which were covered by Rwanda’s Social Security Board’s medical insurance scheme for formal sector workers.

Kanyange’s journey is a reminder of the impact of cervical cancer research, funding, and treatment in Rwanda and the strides the country has made in fighting the disease. Most cervical cancer cases are caused by the human papillomavirus (HPV), a common sexually transmitted virus. Data on the prevalence of HPV in Rwanda is limited, but regionally, experts have found that it affects around 5 percent of women.

In 2011, Rwanda became the first African country to introduce the HPV vaccine through a program coordinated by the Ministry of Health and the private pharmaceutical company Merck, in collaboration with Gavi. Girls aged 12 receive the HPV vaccine while in school. The vaccination program targets this age group because most girls in Rwanda attend primary school and are not yet sexually active. The World Health Organization (WHO) broadly recommends HPV vaccines for girls aged 9 to 14 years.

“Vaccinating in schools is the best strategy to reach many girls,” explained Hassan Sibomana, director of vaccination programs at Rwanda Biomedical Centre (RBC). This method simplifies the process for healthcare workers and minimizes costs by leveraging existing school infrastructure.

Since its inception, the HPV vaccination program has vaccinated more than 1.5 million girls, achieving a 90 percent coverage rate, and reducing the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. Programs like those instituted in Rwanda have drastically changed the landscape of global health by enabling countries to reevaluate funding priorities and invest in prevention, according to a May 2012 report by researchers at the National Institutes of Health.

One challenge of rolling out the vaccination program has been combating misinformation. Sandrine Iradukunda, a women’s health advocate based in Kigali, recalls when the program first reached schools in 2011. While she was 15 and outside the Rwandan government’s designated age range to receive the HPV vaccine, her parents were skeptical about her 13-year-old  sister getting it. “They were doing this huge vaccination campaign in schools, but it kind of felt like we didn’t know what was going on,” she said. Parents worried that the vaccine could cause cancer or infertility.

The government rolled out a nationwide campaign that included speeches by healthcare professionals, local government officials, clergy, and Rwanda's First Lady, Jeanette Kagame. The goal was to educate parents and children about the new vaccine. There were also announcements in local media as part of a vaccine communication strategy, and health officials trained teachers to discuss cervical cancer and the vaccine with their students. Despite progress in discussing sexual and reproductive health, HPV and cervical cancer are still taboo topics in Rwanda. 

“We talk about period poverty, and everyone is involved; we are donating pads,” she said, referring to the lack of access to proper menstrual products. “But when it comes to cervical cancer, our society is detached from it. They don’t want to go there.” 

Iradukunda has made it her mission to break the silence. Her passion for advocacy emerged when, in 2022, doctors spotted benign cysts in her ovaries, which motivated her to learn more about women’s health. As she explored further, she was struck by a lack of research on the topic. And through conversations with other women in her community, Iradukunda discovered that many believed gynecological visits were only necessary for those who are married or pregnant.

Iradukunda said awareness is the key to starting a dialogue among women and girls. She believes campaigns should be continuous, extending beyond symbolic awareness months, and meaningfully target young people and parents. Organizations such as Rwanda Cancer Relief and the Imbuto Foundation have made education and awareness core aspects of their missions, implementing programs on adolescent sexual and reproductive health, as well as cancer, for students, educators, and healthcare providers. 

Cervical cancer remains the leading cancer among women in Rwanda, and many women are diagnosed at an advanced stage, when treatment is more complicated. Globally, cervical cancer is the 4th most common cancer in women, with nearly 350,000 deaths in 2022, according to the WHO. Yet, unlike many other cancers, cervical cancer is highly preventable and treatable. 

“It’s a cancer that gives us time to act,” said Francois Uwinkindi, division manager of the Non-Communicable Diseases Division at the Rwanda Biomedical Center. To him, the continued spread of the disease demonstrates a failure of the global healthcare system to respond to the need with early detection, prevention, and awareness campaigns to fight medical misinformation.

“The more you’re aware, educated, and have resources, the more likely you will catch the disease in time,” Uwinkindi said.

Research shows that eliminating cervical cancer is directly linked to gender equity. A 2020 study published in the International Journal for Equity in Health demonstrated how distributing the HPV vaccine can help reduce gender disparities, estimating the impact in three countries – Tanzania, India, and the United Kingdom. Researchers developed a model that measures how HPV vaccination reduces cervical cancer cases and deaths. They then estimated how these improvements translate into higher labor force participation and lower maternal mortality rates. In all three countries, the HPV vaccine is estimated to prevent a majority of cervical cancer cases. Researchers have found that when women are healthier, they are more likely to work and contribute to the economy. And, as HPV vaccination improves women’s health, it’s also linked to a slight reduction in maternal death and improvement in the gender inequality index (GII), which measures gender gaps in health and employment.

A significant policy breakthrough has been integrating cancer screening and treatment into Rwanda’s community-based health insurance program, Mutuelle de Santé. Starting in July 2025, cancer treatment will be covered, making care more accessible. Rwanda is strengthening funding for the program and other economic development initiatives through tax policy reforms, including the introduction of higher taxes on tobacco and alcohol. These reforms are expected to generate around $200 million over the next five years. Large corporations such as MTN and Airtel also contribute three percent of their net profits to the insurance program.

Sibomana of the RBC believes that the success of Rwandan healthcare will continue to be defined by a prolonged commitment to advancing science and medicine to ensure a future where no woman in Rwanda has to endure a vaccine-preventable disease such as cervical cancer. “We believe in science,” he said. “Vaccines are a human right, and no human right should exclude girls.”